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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 3  |  Page : 32-35

Telemedicine in the era of COVID-19: The East and the West


1 Prof, Department of Community Medicine, AFMC, Pune, Maharashtra, India
2 Chief Medical Officer, Consultant (Full Time) THDC India Ltd, Rishikesh, Uttarakhand, India
3 Prof, Department of Public Health, California State University, Long Beach, California, USA

Date of Submission06-Jul-2020
Date of Decision10-Jul-2020
Date of Acceptance15-Sep-2020
Date of Web Publication09-Oct-2020

Correspondence Address:
Col Maninder Pal Singh Pardal
DADH, HQ 41 Artillery Division, PIN 908441, C/o 56 APO, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_86_20

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  Abstract 


Introduction: Telemedicine implies the application of clinical medicine by telephone, internet, or any other such networks for the purpose of consulting or performing various examinations or medical procedures. The present pandemic of COVID-19 is the ideal time to evolve telemedicine and increase its utilization for the well-being of humankind. Historical Background: Electrocardiogram transmission over telephone lines is the oldest record of telemedicine in the first half of the 20th century. Teleradiology commenced in India in 1996. The National Telemedicine Taskforce was set up by the Government of India, in 2005. The Arizona State Legislature established the Arizona Telemedicine Program in 1996. Medical devices to capture images were developed in the 1990s. Present Scenario in the East: Besides implementing various national-level projects, India has extended telemedicine services to South Asian and African countries. The Apollo Telemedicine Networking Foundation has grown to 115 centers, including 9 overseas. Recently, the Government of India has launched telemedicine solutions in the form of Social Endeavour for Health and Telemedicine and eSanjeevani. Comprehensive guidelines on telemedicine have also been issued during the COVID-19 pandemic. The Indian Navy is in the process of establishing teleconsultation centers on board several ships, submarines, remote locations, islands, and naval hospitals. Present Scenario in the West: Telestroke is the largest care provider for patients with stroke in the country. The field of dermatology is particularly suited for telemedicine. Telemedicine at sea is an integral part of rescue procedures. One of the fundamental components of medical assistance at sea is the Telemedical Maritime Assistance Service. Socioethical and Legal Considerations: Legal and regulatory measures will be a challenge with the rapidly spreading telemedicine network. Conflicting laws of different nations are some of the other legal issues in telemedicine. There exists an urgent need for specific legislation on telemedicine in India. In the USA, telemedicine covers various legal and regulatory issues at the state and federal levels. Limitations: Limited reimbursement or restrictions on reimbursement from insurance providers, quality of the patient–physician relationship, the quality of the examination, and the quality of care are a few barriers to telemedicine. The social limitation is probably the biggest limitation of telehealth. Conclusion: Despite several barriers, telehealth has shown remarkable growth during the COVID-19 pandemic. India with its large medical and IT manpower and expertise is emerging as a global leader in the field of telemedicine. The COVID-19 pandemic has made telemedicine more relevant than ever.

Keywords: Telemedicine, COVID-19, ethics, technology


How to cite this article:
Pardal MP, Rajiva K, Orkeh GO. Telemedicine in the era of COVID-19: The East and the West. J Mar Med Soc 2020;22, Suppl S1:32-5

How to cite this URL:
Pardal MP, Rajiva K, Orkeh GO. Telemedicine in the era of COVID-19: The East and the West. J Mar Med Soc [serial online] 2020 [cited 2020 Nov 27];22, Suppl S1:32-5. Available from: https://www.marinemedicalsociety.in/text.asp?2020/22/3/32/297595




  Introduction Top


Telemedicine implies the application of clinical medicine by telephone, internet, or any other such networks for the purpose of consulting or performing various examinations or medical procedures. Its simpler form may involve two health professionals discussing a case over the telephone. On the other hand, telemedicine may be as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between various specialists in two or more countries.[1]

Telemedicine plays a crucial role in providing medical care at inaccessible places and during pandemic due to any communicable disease. The present time is prudent to evolve telemedicine and its utilization for the well-being of humankind.

The global pandemic of COVID-19 has caused widespread infections, disease, and death, mandating “social distancing” in order to control the spread of infection.[2] Due to the present COVID-19 pandemic, the shift from clinical care to telemedicine has been hastened.


  Historical Background Top


The earliest published record of telemedicine is in the first half of the 20th century when electrocardiogram was transmitted over telephone lines. From then to today, telemedicine has come a long way in terms of both health-care delivery and technology. A major role in this was played by the National Aeronautics and Space Administration and the Indian Space Research Organization.[3]

Teleradiology was one of the first branches of telemedicine to commence in India in 1996.[4] The National Telemedicine Taskforce was set up by the Ministry of Health and Family Welfare, Government of India, in 2005.[3]

The Arizona State Legislature was instrumental in establishing the Arizona Telemedicine Program in 1996.[5]

Very little progress took place in the field of telemedicine in the 1970s and 1980s, with the exception of the telemetry of medical data. Medical devices which were suited to capture images and other data in digital electronic form were developed in the 1990s. Besides, high-speed bandwidth telecommunication systems were developed and installed worldwide. These factors triggered an explosion and interest in telemedicine in this era.[6]


  Present Scenario in the East Top


Besides implementing various national-level projects, India has extended telemedicine services to South Asian and African countries. The standards for Telemedicine Systems have been defined by the Department of Information Technology. Government and private telemedicine providers, besides a few societies and associations in India, are actively engaged to create awareness about telemedicine.[7]

The Apollo Telemedicine Networking Foundation has grown to 115 centers, including 9 overseas. It is the oldest and largest multispecialty telemedicine network. It has provided over 57,000 teleconsultations, and patients have been evaluated from distances ranging from 120 to 4,500 miles.[8]

Acharya RV and Rai JJ observed that approximately 80% of patients and all doctors were satisfied regarding the quality of treatment provided through telemedicine in India. Telemedicine was found to be cost-effective by nearly 90% of participants. About 47% of problems reported by doctors were due to technical issues and 39% due to time scheduling by doctors. Being uncomfortable in facing the camera was reported by 31% of patients, whereas 24% of patients had technical issues.[9] In India, technology-enabled screening of dental conditions, cardiac arrhythmias, tympanic membrane disorders, blood oxygenation levels, optic nerve disorders, and neurological fitness are being carried out.[10]

For the purpose of providing health-care facilities in rural areas, the Government of India has launched a telemedicine initiative in collaboration with Apollo Hospitals named Social Endeavour for Health and Telemedicine.[11]

A web-based comprehensive telemedicine solution “eSanjeevani” has also been launched by the Ministry of Health and Family Welfare, Government of India. It has been developed by the Centre for Development of Advanced Computing (C-DAC) in Mohali.[12]

Recently, the Government of India has issued comprehensive guidelines with the purpose of rendering practical advice to doctors and encourages all services and models of care to consider the use of telemedicine for day to day practice. The guiding principle for telemedicine consultation should be the professional judgment of the doctor. These guidelines have lucidly given various flow charts for teleconsultation for the first consult, follow-up consult, and teleconsultation between a health worker and a registered medical practitioner.[13]

The Indian Navy is in the process of establishing teleconsultation centers (TCC) on several ships and submarines, where a medical officer is available, selected remote locations, islands, and naval hospitals over a network. A laptop with the appropriate software will capture the requisite vital parameters from the Biomedical Data Acquisition System, which in turn will record the same when connected to the patient. Besides, telemedicine specialist centers (TSCs) are being established in selected naval hospitals for the purpose of providing consultation in the event of any requirement. A few selected afloat platforms where a specialist is available and few peripheral hospitals will function in dual mode, i.e., they will function as TCC and TSC as the situation demands.[14],[15]


  Present Scenario in the West Top


In 1999, “telestroke” was introduced. Telestroke implied the provision of acute stroke care from a remote neurologist to a patient in an emergency department. Telestroke has now become mainstream. Telestroke is the largest care provider for patients with stroke in the country is now not a major medical center but a telemedicine company.[16]

Several subspecialty fields have either experimented with or implemented telemedicine platforms for remote consultation. The field of dermatology is particularly suited for telemedicine. Diagnostic images of dermal disorders along with a brief history can be remotely accessed by teledermatologists. Images or live teleconferencing are some of the modalities which can be used for this purpose. Subsequently, diagnosis and management can also be conveyed through teledermatology.[17]

The Intuitive Surgical Inc.'s da Vinci Surgical System, found in operating rooms worldwide, is presently the most prominently available multipurpose robotic surgery system approved by the US Food and Drug Administration.[18]

Centralized operations, one virtual technology platform, standardized training, and connectedness for all the locations have revolutionized the telemedicine model of the Mayo Clinic. A significant number of studies indicating high patient satisfaction with telemedicine have led professionals to accept it as a fact.[19]

Telemedicine at sea is an integral part of rescue procedures. One of the fundamental components of medical assistance at sea is the Telemedical Maritime Assistance Service. Research and clinical investments have not yet benefitted telemedicine at sea as much as onshore telemedicine. Besides, telemedicine at sea and onshore bear major structural, practice, and policy differences.[20],[21]


  Socio-Ethical and Legal Considerations Top


Legal and regulatory measures will be a challenge with the rapidly spreading telemedicine network. Maintaining standards, cyber security, and privacy is the need of the hour. For example, if a telemedicine-assisted surgery fails, due to network issues, who will be held responsible?Should it be the surgeon, the engineer, or the satellite provider?Another point to ponder is does telemedicine-based diagnosis and treatment have any legal status? Conflicting laws of different nations regarding rights and duties of doctors and patients, norms of practicing medicine, list of approved drugs for human consumption etc., information piracy, are some of the other legal issues in telemedicine. Quacks offering medical advice and prescribing drugs over the internet poses another serious problem.[1]

Telemedicine is faced with key medicolegal and ethical issues such as informed consent, doctor–patient relationship, rights of the patient, malpractice, and confidentiality. Ateriya et al. explored the global as well as the Indian legal perspective pertaining to telemedicine. Since specific laws for registration and practice of telemedicine are conspicuous by their absence in India, this is a deterrent for medical practitioners to engage in telemedicine. Therefore, there exists an urgent need for specific legislation on telemedicine in India.[22]

In the USA, telemedicine covers various legal and regulatory issues at the state and federal levels. These aspects include professional licensure, informed consent, privacy and security, fraud and abuse, reimbursement requirements, and standard of care requirements. These legal and regulatory issues are very often complex and ambiguous. The rapid proliferation and evolution of telemedicine networks in recent years has led to this ambiguity. As a consequence of this, regulators are unable to cope up in framing new and adequate laws.[23]

Limitations

Limited reimbursement or restrictions on reimbursement from insurance providers, quality of the patient–physician relationship, the quality of the examination, and the quality of care are a few barriers to telemedicine.[24] The ability to build trust and rapport is much more difficult through telemedicine than in person. Most telehealth encounters are the first encounter of the patient with the clinician. The quality of the remote clinician and/or the variability in the qualifications among remote clinicians could be masked on account of the limited familiarity with the telehealth clinician.[24]

The social limitation is probably the biggest limitation of telehealth. Differential access to telecommunication technologies based on various geographic and social factors or the digital divide poses a major barrier to the adoption of telehealth. The digital divide, combined with the burden of chronic conditions among the older population, undermines the fundamental aim of telehealth to increase access to care for the geriatric population, those in greatest need.[24]


  Conclusion Top


Despite all the barriers, the growth of telehealth since the inception of the current COVID-19 pandemic is remarkable and expected to grow further with greater impetus.[16] It will also provide greater flexibility to both patients and doctors, as regard to their location and availability.[24] As the digital divide narrows and smartphones become more ubiquitous, telehealth will enable more people to receive care.[24]

India holds tremendous promises and is emerging as a global leader in the field of telemedicine. This has been facilitated by its large medical and IT manpower and expertise.[25] A balance between clinical care and medical care through telemedicine will be more prudent in order to decrease the burden on the state and patient and also to provide maximum relief and comfort to the patient.

The COVID-19 pandemic has made telemedicine more relevant than ever, as telemedicine has been found to be an effective way of rational allocation of medical resources, besides providing timely care while minimizing exposure to protect health-care workers and patients.[26],[27],[28]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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